Enseñanza de la multiplicación desde un enfoque constructivista en tercero y cuarto año de Educación General Básica

La presente investigación tiene como objetivo demostrar teóricamente la importancia de la enseñanza de la multiplicación a partir de un enfoque constructivista en el tercero y cuarto año de Educación General Básica, años en los que esta enseñanza se profundiza. En efecto, este trabajo monográfico busca responder a las siguientes interrogantes: ¿En qué consiste la multiplicación y su proceso? ¿Cuál es la diferencia de enseñar la multiplicación desde un enfoque tradicional y un enfoque constructivo? Según la Actualización y Fortalecimiento Curricular (2010): ¿Cómo se debe desarrollar su proceso de enseñanza? ¿Qué estrategias se pueden utilizar para trabajar en la comprensión de la multiplicación en el tercero y cuarto año de Educación General Básica? Para responder estas preguntas se recurre a la revisión de información bibliográfica procedente de revistas, libros y artículos de diferentes autores, que facilitan cumplir con los objetivos planteados. Finalmente, se concluye que la enseñanza - aprendizaje basada en los lineamientos del enfoque pedagógico constructivista tiene como resultado la comprensión que los estudiantes necesitan tener hacia la multiplicación para poder utilizarla en su vida académica y cotidiana. Por tal razón se afirma que, la importancia de enseñar la multiplicación desde un enfoque constructivista se fundamenta en que este lineamiento pedagógico propende el uso de dicha operación matemática en la resolución de problemas, desarrollando así su pensamiento lógico – matemático y el razonamiento, a diferencia de lo que ocurre con el tradicionalismo en el que se memoriza por corto plazo.

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

BACKGROUND: It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness.

METHODS: A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey.

RESULTS: From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists.

CONCLUSION: Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a mental health crisis.

First aid for eating disorders

The objective of this study was to develop first aid guidelines, based on expert consensus, that provide members of the community with information on how to assist someone who is thought to be developing or experiencing an eating disorder. An online Delphi study was carried out with expert panels consisting of 36 clinicians, 27 care-givers and 22 consumers. The panel members rated statements that described potential first aid actions. If between 80 and 100 percent of all three panels rated a statement as either Essential or Important, the statement was endorsed as a guideline. Three rounds were conducted before consensus was reached. From a total of 456 statements, 200 were endorsed as guidelines. A cohesive guideline document was developed by writing the endorsed statements into sections of prose based on common themes. Clinicians, care-givers and consumers were able to reach consensus about guidelines for eating disorder first aid. Further research is needed to evaluate their efficacy.

Power quality impacts in a typical microgrid

Microgrid (MG) power system plays an important role to fulfill reliable and secure energy supply to critical loads of communities as well as for communities in remote area. Distributed Generation (DG) sources integrated in a MG provides numerous benefits, at the same time leads to power quality issues in the MG power distribution network. Power Quality (PQ) issue arises due to the integration of an intermittent nature of Renewable Energy (RE) sources with advanced Power Electronics (PE) converter technology. Also, presence of non-linear and unbalancing loads in MG seems to affect PQ of the energy supply in power distribution network. In this paper, PQ impacts like; power variation, voltage variation, Total Harmonic Distortion (THD), and Unbalance voltage level have been analysed in Low Voltage (LV) distribution network of typical MG power system model. In this study, development of MG model and PQ impact analysis through simulation has been done in PSS-Sincal software environment. Analysis results from the study can be used as a guideline for developing a real and independent MG power system with improved PQ conditions.

The importance of taste on dietary choice, behaviour and intake in a group of young adults

The 'taste of food' plays an important role in food choice. Furthermore, foods high in fat, sugar and salt are highly palatable and associated with increased food consumption. Research exploring taste importance on dietary choice, behaviour and intake is limited, particularly in young adults. Therefore, in this study a total of 1306 Australian university students completed questionnaires assessing dietary behaviors (such as how important taste was on food choice) and frequency of food consumption over the prior month. Diet quality was also assessed using a dietary guideline index. Participants had a mean age of 20 ± 5 years, Body Mass Index (BMI) of 22 ± 3 kg/m(2), 79% were female and 84% Australian. Taste was rated as being a very or extremely important factor for food choice by 82% of participants. Participants who rated taste as highly important, had a poorer diet quality (p = 0.001) and were more likely to consume less fruit (p = 0.03) and vegetables (p = 0.05). Furthermore, they were significantly more likely to consume foods high in fat, sugar and salt, including chocolate and confectionary, cakes and puddings, sweet pastries, biscuits, meat pies, pizza, hot chips, potato chips, takeaway meals, soft drink, cordial and fruit juice (p = 0.001-0.02). They were also more likely to consider avoiding adding salt to cooking (p = 0.02) and adding sugar to tea or coffee (p = 0.01) as less important for health. These findings suggest that the importance individuals place on taste plays an important role in influencing food choice, dietary behaviors and intake.

Can early dietetic intervention improve outcomes in patients with hip fracture?

Aim: To assess whether the introduction of a new approach to nutritional care for hip fracture patients, in both acute and subacute admissions, can improve nutritional status, length of stay and pressure injuries. Methods: Medical records of patients admitted to Austin Health, Melbourne, Australia with a fractured hip between January and June 2014 after implementation of a new nutritional care guideline were compared to a historical control group admitted between January and June 2013 prior to introduction of the guideline. Data were collected for both acute and subacute admissions and included length of stay, date of first contact with a dietitian, subjective global assessment category and occurrence of pressure injuries. Results: There was a significantly shorter length of stay overall for patients who received care under the new guideline (21.6 ± 15.1 vs 26.4 ± 20.4 days; P = 0.043) and during the subacute admission (20.1 ± 10.6 vs 28.8 ± 15.8 days; P < 0.001); however, there was no significant difference in the acute hospital length of stay period. The post-guideline group had a significantly shorter time between admission and first contact with a dietitian (4.8 ± 3.3 vs 7.5 ± 6.2 days; P < 0.001). Post-guideline patients also had a significantly lower incidence of pressure injuries with 29, compared to 41 in pre-guideline patients (P = 0.045). There were significantly less malnourished patients in the post-guideline group compared to the pre-guideline group across both acute and subacute admissions (29% vs 35%; P = 0.015). Conclusions: A nutritional care guideline for patients with hip fractures is associated with improved patient outcomes with a significant reduction in overall and subacute length of stay and pressure injury incidence and earlier dietetic assessment and intervention.

Gender difference in the use of coronary interventions for patients with acute coronary syndrome: experience from a major metropolitan hospital in Melbourne, Australia

BACKGROUND: Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS). OBJECTIVES: The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009-2012. METHODS: We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina (UA), ST-segment-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). RESULTS: The mean age of the patients was 64.3 years and 624 (30%) were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent (adjusted odds ratio 0.61, 95% confidence intervals 0.39-0.96) and 66% less likely to receive grafts (adjusted OR 0.34, 95% CIs 0.13-0.93). Women diagnosed with NSTEMI were 44% less likely to receive grafts (adjusted OR 0.56, 95% CIs 0.37-0.83). Younger women aged 35-49 years were less likely to receive an angioplasty stent, and older women >50 years were less likely to receive grafts. CONCLUSIONS: Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.

An improved stability criterion for time-delay power systems with electric vehicles and high voltage direct current power links

This paper presents an improved stability criterion for load frequency control (LFC) of time-delay power systems including AC/HVDC transmission links and EVs. By employing a novel refined Jensen-based inequality, an improved stability condition is derived in terms of feasible linear matrix inequalities (LMIs) which allow us to compute the maximal upper bounds of time-delay ensuring stability of the LFC scheme equipped with an embedded controller. Cases studies here are implemented for LFC scheme of a two-area power system, which is interconnected by parallel (AC/HVDC) links, with embedded proportional integral (PI) controller for discharged EVs. The relationships between the parameters of PI controller, supplementary control of HVDC links and delay margins of the LFC scheme are also discussed. As a consequence of facts, the results of delay margins can be used as a guideline to tune PI controller and set-up parameters for HVDC control.

Quantifying wildlife-watching ecotourism intensity on an endangered marine vertebrate

Here, we show how seasonal changes in animal density drive strategic shifts in the activities of wildlife-watching operators. These shifts result in high viewing intensity when animal densities are low, highlighting the need for modifications to existing wildlife-watching guidelines. We used the endangered loggerhead sea turtle Caretta caretta as a model species that exhibits staggered departure from an important breeding area (Zakynthos, Greece, Mediterranean) over a 2-month period (July to August) when tourism is at a peak, to investigate changes in wildlife-watching strategies, zoning effectiveness and voluntary guideline compliance over time. We used a combination of direct land-based observations, global positioning system tracking (of wildlife-watching vessels and turtles) and models. The modelled number of turtles present in the breeding area decreased from >200 in July to <50 in August, while the intensity of turtle-viewing increased from a mean 1.5 to 6.1 wildlife-watching vessels per turtle-viewing event (i.e. concurrent and consecutive vessels observing a single turtle) over the same period, respectively. During this period, the wildlife-watching strategy changed and compliance to guidelines reduced (exacerbated by recreational vessels). However, wildlife-watching activity was limited to a highly restricted 0.95-km2 nearshore area, overlapping with just 9.5% of the core habitat area used by turtles. Our results have broad implications (whale watching etc.) by showing the importance of taking the number of animals available for viewing into consideration when assessing wildlife-watching activity and when designing viewing guidelines, particularly for populations where numbers noticeably fluctuate.

Should patients in a persistent vegetative state be allowed to die? Guidelines for a new standard of care in Australian hospitals

In this article we will be arguing in favour of legislating to protect doctors who bring about the deaths of PVS patients, regardless of whether the death is through passive means (e.g. the discontinuation of artificial feeding and respiration) or active means (e.g. through the administration of pharmaceuticals known to hasten death in end-of-life care). We will first discuss the ethical dilemmas doctors and lawmakers faced in the more famous PVS cases arising in the US and UK, before exploring what the law should be regarding such patients, particularly in Australia. We will continue by arguing in favour of allowing euthanasia in the interests of PVS patients, their families, and finally the wider community, before concluding with some suggestions for how these ethical arguments could be transformed into a set of guidelines for medical practice in this area.

The adoption of roles by primary care providers during implementation of the new chronic disease guidelines in urban Mongolia: a qualitative study

(1) BACKGROUND: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia;

(2) METHODS: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation;

(3) RESULTS: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover;

(4) CONCLUSIONS: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

The diagnosis of attention-deficit/hyperactivity disorder in Australian children: current paediatric practice and parent perspective

Aims In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD. Methods Design: cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis. Setting: private/public paediatric practices in Western Australia and Victoria, Australia. Main outcome measures: paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire. Results Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD. Conclusions Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician.

iPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management

We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent(®) selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension. iPrevent(®) then presents risk-adapted, evidence-based, guideline-endorsed management options. Development was an iterative process with regular feedback from multidisciplinary experts and consumers. To verify iPrevent(®), risk factor data for 127 cases derived from the Australian Breast Cancer Family Study were entered into iPrevent(®), IBIS (v7.02), and BOADICEA (v3.0). Consistency of the model chosen by iPrevent(®) (i.e., IBIS or BOADICEA) with the programmed iPrevent(®) model choice algorithm was assessed. Estimated breast cancer risks from iPrevent(®) were compared with those attained directly from the chosen risk assessment model (IBIS or BOADICEA). Risk management interventions displayed by iPrevent(®) were assessed for appropriateness. Risk estimation model choice was 100 % consistent with the programmed iPrevent(®) logic. Discrepant 10-year and residual lifetime risk estimates of >1 % were found for 1 and 4 cases, respectively, none was clinically significant (maximal variation 1.4 %). Risk management interventions suggested by iPrevent(®) were 100 % appropriate. iPrevent(®) successfully integrates the IBIS and BOADICEA risk assessment models into a decision support tool that provides evidence-based, risk-adapted risk management advice. This may help to facilitate precision breast cancer prevention discussions between women and their healthcare providers.

Identifying and integrating patient and caregiver perspectives for clinical practice guidelines on the screening and management of infectious microorganisms in hemodialysis units

Introduction: The integration of patient and caregiver input into guideline development can help to ensure that clinical care addresses patient expectations, priorities, and needs. We aimed to identify topics and outcomes salient to patients and caregivers for inclusion in the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) clinical practice guideline on the screening and management of infectious microorganisms in hemodialysis units.

Methods: A facilitated workshop was conducted with 11 participants (patients [n = 8], caregivers [n = 3]). Participants identified and discussed potential topics for inclusion in the guidelines, which were compared to those developed by the guideline working group. The workshop transcript was thematically analyzed to identify and describe the reasons underpinning their priorities.

Findings: Patients and caregivers identified a range of topics already covered by the scope of the proposed guidelines and also suggested additional topics: privacy and confidentiality, psychosocial care during/after disease notification, quality of transportation, psychosocial treatment of patients in isolation, patient/caregiver education and engagement, and patient advocacy. Five themes characterized discussion and underpinned their choices: shock and vulnerability, burden of isolation, fear of infection, respect for privacy and confidentiality, and confusion over procedural inconsistencies.

Discussion: Patients and caregivers emphasized the need for guidelines to address patient education and engagement, and the psychosocial implications of communication and provision of care in the context of infectious microorganisms in hemodialysis units. Integrating patient and caregiver perspectives can help to improve the relevance of guidelines to enhance quality of care, patient experiences, and health and psychosocial outcomes.

Modèles organisationnels et compétences infirmières en gestion de lits

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option formation des sciences infirmières